Active NPI
John Peterson
- Clinical Social Worker
- Anoka, MN
National Provider Identifier
1245549344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 1833 3Rd Ave
Anoka, MN 55303-2424 - Phone
- (763) 421-5535
- NPI assigned
- Oct 7, 2010
- Last updated
- Jun 23, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | MN | Primary |
Addresses
Primary practice location
1833 3Rd Ave
Anoka, MN 55303-2424
Mailing address
5373 Jackson Dr
Saint Paul, MN 55112-1445
Phone (612) 910-3558
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Innovations, Inc. | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba LifeStance Health
- Counseling Psychologist
- Anoka, MN
- NPI 1992862783
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308787200000",
"number": "1245549344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5373 JACKSON DR",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551121445",
"telephone_number": "612-910-3558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1833 3RD AVE",
"city": "ANOKA",
"state": "MN",
"postal_code": "553032424",
"telephone_number": "763-421-5535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-10-07",
"last_updated": "2011-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anoka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.